HALL, Austria — Forensic crews scraping away dirt from the remains of the Nazi-era psychiatric patients were puzzled: The skeletal fingers were entwined in rosary beads. Why, the experts wondered, would the Nazis — who considered these people less than human — respect them enough to let them take their religious symbols to their graves?

It turns out they didn’t.

A year after the first of 221 sets of remains were exhumed at a former Austrian hospital cemetery, investigators now believe the beads were likely nothing more than a cynical smokescreen, placed to mislead relatives attending the burials into thinking that the last stage of their loved ones’ lives was as dignified as their funerals.

But skeletons don’t lie. Forensic work shows that more than half of the victims had broken ribs and other bone fractures from blows likely dealt by hospital personnel. Many died from illnesses such as pneumonia, apparently caused by a combination of physical injuries, a lack of food and being immobilized for weeks at a time.

Neither do medical records, which show that medical personnel cursed their patients as “imbeciles,” ”idiots” and “useless eaters.”

Indeed, there is now little doubt that for many of the dead — mentally and physically disabled people considered by the Nazis to be human garbage — their final months were hell on Earth.

Nazi extermination of the mentally and physically deficient has been documented since the end of World War II. But information gathered from the hospital cemetery in Hall, an ancient Tyrolean town of narrow, cobble-stoned alleys, cozy inns and graceful church spires east of Innsbruck, has filled out the picture in chilling new ways.

Historians, anthropologists, physicians and archaeologists say the Hall project represents the first time that investigators can match hospital records with remains, allowing them to identify, for example, cases in which patients had broken ribs, noses and collarbones that were not listed in their medical histories, suggesting that the patients had been beaten by those responsible for their care.

Faced with the horrors of the findings, those involved in the probe struggle to maintain the detached attitude of an investigator.

“At first, I sat here and worked through these documents in a relatively dry manner from the point of view of a scientist,” psychiatrist Christian Haring said. “But as you read on at some point, you suddenly find yourself in a world where the goose-bumps appear.”

Anthropologist George McGlynn said more than half of the sets of remains have broken bones, many of them unexplained in the patients’ medical records.

“Why is a stubbed toe talked about in three different (documents), but six rib fractures that cause terrible pain isn’t even mentioned?” he asked.

While such injuries did not kill directly, they may often have led to death. Many of the patients are listed as dying of pneumonia, and McGlynn said the “scary conclusion” is that rib injuries combined with sedation and forced immobility — patients are suspected to have been strapped to their beds for weeks at a time — may have generated fatal incidences of the disease.

“Nobody is being executed here, like you see in concentration camps,” he said. “It was done in a more sinister, insidious way — people are loaded up with drugs until they get a lung infection.”

Forensic examination of the bones shows infection that started at the skin level then “goes right into the muscle and all the way to the bone,” McGlynn said.

Others apparently starved — if not to death, then to the point where they were susceptible to diseases that then killed them.

“We can assume that the patients suffered massively from hunger,” said Haring, the psychiatrist, speaking of “enormous” losses in weight.

The Nazis called people deemed too sick, weak or disabled to fit Hitler’s image of a master race “unworthy lives,” in the terrible culmination of the cult of eugenics that gained international popularity in the early 1900s as a way to improve the “racial quality” of future generations.

“Patients, who on the basis of human judgment are considered incurable, can be granted mercy death after a discerning diagnosis,” Hitler wrote in a 1939 decree that opened the flood gates to the mass killings.

More than 70,000 such people were killed, gassed to death or otherwise murdered between 1939 and 1941, when public protests stopped most wholesale massacres. From then until the end of the war in 1945, the killings continued at the hands of doctors and nurses. In all, at least 200,000 physically or mentally disabled people were killed by medication, starvation, neglect or in the gas chambers during the war.

After 1941, McGlynn said, “a lot of the smaller institutions were given carte blanche to take care of things themselves. No longer were people being transported to (killing) centers. They were being put to sleep right there.”

Hundreds of psychiatric patients from Hall were among those shipped to killing centers before 1941, but what happened there after that was unknown until two years ago, when an archivist searching through old hospital files discovered the graveyard during a hospital expansion.

The records show that as the war progressed, and able-bodied men and women became scarce behind the front lines, the Nazis made a cynical adjustment in their measurement of patients’ value.

“‘Worthy of life’ and ‘unworthy of life’ were the terms used back then,” Haring said. “The difference was ability to work or not.”

Excerpts of medical histories provided to The Associated Press described one of the patients as suffering from “imbecility,” but most were objective, bereft of demeaning descriptions. McGlynn, however, said he had examined records that show emotional abuse in addition to the physical violence the remains attest to.

“People are being threatened: ‘If you don’t do this we are going to stuff this tube down your nose and pump you full of stuff,’” he said. “These people were at the mercy of their captors.”

Other evidence backs up his findings.

Documents show that the cemetery was created in 1942, a year after the formal end of the mass-killing campaign meant that Hall patients could no longer be shipped to gas chambers. It was shut down and abandoned in 1945, when the war ended. During that time, deaths in the psychiatric ward rose from an average of 4 percent a month in early 1942 to as high as 20 percent in some months before the end of the war.

Haring, an affable, soft-spoken man, is visibly shaken as he speaks of the horrors perpetrated by the previous generation of psychiatrists. But he hesitates to assign individual guilt to anyone caught up in the inhuman machinery of the Third Reich.

“It is easy for us now to point the finger and say ‘what have they done?’” he said. “But … I am not sure that I would have acted differently. We were simply paralyzed.”